Intercultural healthcare: My experience

I am now in the trenches of the second year of medical school. Most hours of my day are spent juggling studying neuro-anatomy and physiology with fending off anxiety about the upcoming USMLE Step 1 boards. It is exhausting to say the least. Rest is not an option. Not only because there is no time, but also because of the associated guilt. The only salvation from this endless cycle is using any extra time I can find for involvements that are truly meaningful. One of these extra-curricular activities is something that I am particularly excited about because it is a reminder of what initially drew me to the field of medicine.

During the ages of 12 to 18 I was responsible for accompanying my grandparents to their doctors’ appointments. From dentist, to ophthalmologist, to cardiologist, I helped my parents out by being a translator while they were at work. It may have seemed like a part of my chores at first, but it quickly became an exciting challenge and learning experience. Even filling out the paperwork required phone calls to my mom for translations or acting out the medical words I did not know. The experience was invaluable and continues to influence every aspect of my life. I developed my love of languages and discovered my interest in patient care in those waiting rooms and doctor visits.

On the other side of almost two years of training I am surprised that my outlook on this very influential experience has changed. Lectures on cross-cultural communication and experience working with non-English speaking patients have made me reconsider the use of family members (especially young children) acting as medical interpreters. While I know from my own personal experience that I did the best that I could, with the best intentions for my grandparents, I know that certain aspects of patient care were lost in translation. Consequently, I am happy to see that there have been strong efforts to increase access to interpreters and provide resources for improved cultural competency in health care. Many hospitals are now mandating that interpreters be available for patients at each visit, either in person or via telephone. OHSU has recently updated their own policy and now requires providers who wish to speak to patients in a non-English language to be certified. These steps may be costly, but I am beginning to see the immense importance of this type of standardization and training.

Just last year, I went to a doctor visit where my grandmother had a professional medical interpreter. She was considering a very complicated and invasive spinal surgery associated with very high risks. I am not sure if the hospital had required it or my mother suggested it, but she was accompanied by an interpreter for the pre-op assessment visit. This two-hour experience in itself revealed to me the complex nature of intercultural medical care. I was in a unique position to witness the dynamic interactions between practitioner, non-English speaking patient, family member, and interpreter. For the first time, I learned what is meant by “a family member’s conflicting agenda” in a patient visit. While both my mother and I were trying to gather information about the risks of the procedure so that we could help make an informed decision, I realize that we were less concerned about sharing that information with the actual patient. It was as if we knew we would have the opportunity to share the details with her when we got home. But what about the patient’s questions and her need to know the information and risks? The only person who was an unbiased aid to the patient was the interpreter – who never failed to translate every word from the patient to the practitioner and back.

It was also very clear that the practitioner’s training and experience with intercultural medical care is a crucial aspect of this interaction. Unfortunately, in the visit with my grandmother, the practitioner seemed most concerned with speeding up the process. From asking the question, to getting the translation, then getting the response, then getting the translation, then answering our separate concerns, it was clear that she was inpatient and only wanted to hear the answers to her paperwork. It is obvious that multiple components including provider training, qualified interpreter access, and patient education are essential to improving quality care in intercultural settings.

Last year I joined the leadership of a student-led initiative to help medical students develop skills in intercultural medicine. We are very pleased to have launched the Intercultural Longitudinal Health Elective this year, which has assigned students proficient in languages including Spanish, Korean, and Mandarin to non-English speaking patients with chronic illnesses. These students will be following their patients over the course of the year at every appointment and acting as their liaison for medical care, to help navigate cultural and language barriers. This experience will give students the opportunity to work closely with non-English speaking patients in a direct care setting in order to increase their comfort and competency for working with intercultural patients in their future practices. It will also give non-English speaking patients with chronic illnesses a resource in the maze of physicians visits and a familiar face that will improve their longitudinal health care needs.

In addition, on March 15 we will be holding the second annual OHSU Bilingual Provider Training Event. This interdisciplinary event is designed to educate students who are interested in providing medical care in non-English languages in the future. Via lectures and small group sessions we aim to highlight challenges and techniques for future bilingual providers and encourage students to make cultural competency a core part of their patient care. We also hope to increase awareness about the collaborative effort of delivering intercultural care via talks from OHSU’s Language Services department, interpreters, and physicians to prepare students to meet these demands as future healthcare providers.

Intercultural medicine is an area that has increasing application in our diverse country. The interplay between patients, family members, interpreters, and practitioners is a collaborative effort that requires patience, practice, and training. I am very excited to be part of such an initiative that will help patients, like my grandmother, have access to the resources and knowledgeable providers that will deliver the best healthcare for their unique needs.

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About the author

Shabnam Ghazizadeh

I’m a coast to coast transplant – born and raised in New York then moved to Oregon where I graduated from Lincoln High School in downtown Portland. My perspective comes from my desire to learn and appreciate culture – culture of a person, a place, an ethnicity. I have a passion for languages and hope to provide bilingual care to patients in my future practice. I enjoy spending time outdoors, laughing, and waiting in line at trendy Portland eateries.

Thank you for talking on this important topic. Thrilled to hear about the event in March! Are you connected to the Intercultural Communication Institute (based in Beaverton) http://www.intercultural.org – a community of some of the best trainers/coaches/educators on Intercultural Communication. The surely could be a great resource. I imagine you already know Riikka Salonen (Manager of Workforce Equity and Inclusion at OHSU) – she has an intercultural training background. Keep up the great work and thanks for finding the time to write this amid your crazy schedule.

It’s always sufficient to have an intercultural supports and services to non English speaking population(s). I agree with Shabnam, I have been working at Inercultural Psychiatric Program (IPP) at OHSU for 20 years, and this program has served up to 17 languages with bilingual and trilingual counselors, who are well trained in mental health, and this has been so effective with much successful outcomes.

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